"My daughter came to me last week and told me that she was concerned with her grandfather. She said that he seemed confused and was very short with her, unlike the way he usually treated her. Since my mom died, he has seemed distant and disengaged in the family," said Mirian. "He had an alcohol problem shortly after mom passed, but that was years ago and it was a horrible situation."
So bad was this, according to Mirian, that he was admitted to the hospital with acute pancreatitis and began to go through delirium tremens (DTs), severe alcohol withdrawal characterized by shaking, confusion, and hallucinations.
"The pandemic and being isolated has brought back the drinking behavior. Going to the senior center in the past seemed to give him the friends that he needed, but being alone caused the relapse. I can't go through this again but I also don't want him to deal with this on his own. As a family, we feel alone," said Mirian. But Mirian's family is certainly not alone as alcohol use has become a coping mechanism for many seniors facing loneliness and boredom brought on by the isolation of the pandemic.
"The so-called lockdown has had a deleterious effect among our seniors," said certified elder law attorney RJ Connelly III. "They know they are at high risk of illness and they are scared. Because of this, we are seeing an inordinate amount of isolation among this group and isolation leads to loneliness, boredom, and feelings of helplessness. In order to deal with those feelings, the easiest thing to turn to is alcohol."
What also was not helpful were the rules during the height of the pandemic. "When the lockdown went into place, gyms, theaters, and malls closed. But liquor stores and grocery stores that sold alcohol were called essential businesses and allowed to remain open," said Attorney Connelly. "This was a recipe for disaster."
In a poll conducted in late January 2021 as part of the University of Minnesota's National Poll on Healthy Aging, it was found that drinking behaviors rose among older Americans during the height of the pandemic, adding to the risks to their health. In that poll, more than 2000 adults aged 50 to 80 were questioned and about 14% of the respondents said that their drinking had increased during the first 10 months of the pandemic. For this group, alcohol was used to improve their mood, allow them to relax, or cope with boredom, stress, or pain.
A full one-third of this group reported that they drank more alcohol in the past year than previously with all in this group stating it was because of loneliness and isolation. When it comes to the amount of drinking, 23% stated that they routinely drink three or more drinks in one sitting and occasional binge drinking, which are signs of problematic alcohol use. Finally, 10% said they use "other" drugs, including marijuana and prescription medications while drinking, which can radically affect the impact that alcohol has on the body.
But let's make no mistake about alcohol, although the pandemic did increase the use among older adults and seniors, it is not a new problem. Statistics indicate that alcohol use by older adults has been on the rise for decades. Between 2002 and 2006, nearly 3 million adults age 50 and over were diagnosed with substance use disorders, including alcohol. That number nearly doubled by 2020. And, these numbers may be conservative.
"Given some of the assistance our offices have provided over the years, it's clear that drinking problems are often overlooked or even misdiagnosed in our senior population," said Attorney Connelly. "For instance, depression, insomnia, and even mood swings can be a symptom of mental health issues, but also a sign of alcoholism. We think it is imperative that those in the medical field who work with older adults do substance abuse screenings when certain warning signs are present."
An Abusing Generation
As discussed earlier, the pandemic is tied to an increase in drinking behaviors, but that increase was occurring for 20 years prior to the onset of COVID, so what is the reason for this? It appears it is a generational thing - the Baby Boomers.
The Baby Boomer demographic was born between 1946 and 1964 and this group had the highest substance abuse rates as teens than any other generation. Although most stopped using drugs recreationally by the time they reached their late 20s and early 30s, changes in their lifestyles and responsibilities upon retirement have seen many pick up the substances again.
In 1990, the oldest of the boomers reached their mid-40s, and since then, this group has seen the most dramatic increases in rates of substance abuse and hospitalizations due to drug and alcohol overdoses. And here's an interesting statistic, more older adults die from overdoses than from the seasonal flu or pneumonia and for the first time in history, deaths from accidental overdoses in this group are higher than in the 25-44 age group. The substances most commonly abused by Boomers include cannabis, heroin, prescription drugs (opioids and benzodiazepines), and alcohol. So what could be causing those in this age group to pick up drugs and alcohol once again?
"I believe it has a lot to do with the very function of aging and that we are living longer," said Attorney Connelly. "Yes, the old habits of their youth may come back, but more as a coping mechanism rather than a party time. Because they live longer, many may lose partners and live alone longer leading to loneliness, trauma associated with losing a spouse due to an illness, empty nest syndrome when children grow and leave the home, some do not have enough money to maintain a lifestyle they had when they were employed so there may be financial difficulties, and of course health issues. Because we live longer, we tend to experience more health issues and we look for ways to deal with these concerns -- this is where the old coping mechanisms begin to return."
Some of the signs that a senior is having a drinking problem are:
Drinking as a way to cope with loss or depression
Consuming alcohol with prescription and over-the-counter medications
Becoming agitated or irritable when they’re sober (which is a sign of alcohol withdrawal)
Exhibiting signs of drunkenness, such as slurred speech and the smell of alcohol on their breath or clothes
Lying about how many drinks they’ve had
Hiding or stashing liquor bottles where they can’t be found
Putting themselves or others in danger due to their drinking habits (driving drunk with kids or others in the car, falling to sleep with a cigarette or stove left on, etc.)
Alcohol's Effects Nearly Every Body Function
One of the biggest concerns of substance abuse among seniors is the effect on health. "Any one of any age who abuses drugs is at risk of developing health issues, but that risk certainly increases with age," says Attorney Connelly. "The older a person gets, the more difficulty their body has processing alcohol. And in addition to the effects on the body, older adults are at higher risks of accidents and falls when under the influence."
Seniors also use more medications than any other age group and alcohol can lead to a number of negative interactions with prescription medications. "Aged-related changes in the body and the brain must always be considered when drinking with medications on board," said Connelly. "The other concern is that when you're older, each interaction with mixing drug and alcohol can be wildly different. This can depend on the amount of alcohol consumed, chronic medical conditions present, functional status, and even what was eaten and drink during the day."
The Metabolization of Alcohol in Seniors
The body's tolerance for alcohol decreases as we age, making it less efficient at metabolizing alcohol and in turn, breaking down other drugs. With a decline in lean body mass, there is less muscle to absorb alcohol. This affects nearly all systems of the body.
Increased blood alcohol levels - Older adults typically have stomach problems due to acid issues and are prescribed Tagamet (cimetidine) and Zantac (ranitidine hydrochloride) which are histamine receptor antagonists used to treat and prevent ulcers by blocking the acid pumps of the stomach. However, when these meds are combined with alcohol, even in small amounts, can raise blood alcohol levels to a point where cognitive and motor skills are affected.
Increases in drug metabolism - those who are long-term heavy users of alcohol induce the body's metabolic system to increase the rate of metabolizing drugs like benzodiazepines (Xanax, Klonopin, Valium, and Ativan, warfarin, phenytoin (Dilantin), propranolol (Hemangeo, Inderal), tolbutamide(Orinase), and isoniazid (Nydrazid), and highly active antiretroviral therapy (HAART) drugs.
Toxic metabolites - another effect of enzyme induction by those who use alcohol heavily is the production of toxic metabolites to the liver when drugs like isoniazid (Nydrazid, Laniazid) and acetaminophen (Tylenol). Those who take statins (Lipitor, Crestor, Zocor) may have hepatoxic effects as well.
Decreases in drug metabolism - Short-term heavy alcohol use, like binge drinking, can inhibit the metabolism of medications. Alcohol competes with drugs such as benzodiazepines, narcotics, and warfarin meaning they are metabolized more slowly and result in increased concentrations of these medications in the blood. The result is that lower doses of the drug are needed to achieve the therapeutic effect and the risk of an overdose is increased.
Antabuse (Disulfiram) Type Reaction - Antabuse is a medication used in the treatment of alcohol abuse by blocking the processing of alcohol in the body. Taking this medication and drinking can lead to a reaction that may include flushing, throbbing headache, breathing problems (e.g., shortness of breath, fast breathing), nausea, vomiting, dizziness, extreme tiredness, fainting, fast/irregular heartbeat, or blurred vision.
Alcohol also interferes with the effectiveness of medications prescribed for many common health issues of seniors. These issues include high blood pressure, diabetes, stomach problems, gout, insomnia, depression, and cognitive impairments. Other conditions, which are not confined just to seniors include liver disease, breast cancer, and seizure disorders.
Gastrointestinal Bleeding - NSAIDS (Ibuprofen) and aspirin when combined with alcohol can cause stomach bleeding. The negative effects of NSAIDS are higher in older adults and when combined with alcohol in this age group can be more toxic.
Sedation - Older adults are much more susceptible to the sedating and impairment of motor skills than younger ones, and when combined with other common prescription medications that older adults take, the results can not only be severe, but deadly. Drugs in this category are benzodiazepines (Xanax, Klonopin, Ativan - see the full list of common benzos by clicking here), tricyclic antidepressants (Elavil, Tofranil - See the full list of common tricyclic antidepressants by clicking here), muscle relaxers (Soma, Robaxin - see full list of common muscle relaxants by clicking here), narcotics (Ultram, OxyContin - see full list of common narcotics by clicking here), sedating antihistamines (Alimemazine, Chlorphenamine - see full list of common sedating antihistamines by clicking here), drugs used to treat neuropathic pain (Neurotin, Lyrica - see full list of common drugs that treat neuropathic pain by clicking here), and barbiturates (Fioricet, Nembutal - see full list of common barbiturates by clicking here).
Hypotension - Alcohol impairs vasoconstriction (the narrowing [constriction] of blood vessels by small muscles in their walls) and when used in combination with some medications used to treat certain conditions like Parkinson's disease, can cause a serious drop in blood pressure resulting in dizziness and falls.
Hypertensive crisis - Beverages containing tyramine (in red wine and beer) can increase blood pressure to a dangerous level when used with some medications for the treatment of depression - click here to see meds involved.
Common Health Issues
As we age, health issues become more common. Moderate to heavy ingestion of alcohol can increase the risk of becoming sick or exacerbate preexisting conditions. There are a number of health problems that can be directly linked to alcohol abuse.
Hypertension - Alcohol has been known to double the risk of hypertension in women who consume two drinks or more daily, and in men who drink 4 or more daily.
Dehydration - Alcohol does not allow the body to reabsorb water efficiently leading to dehydration in seniors who may already have problems with dehydration. Studies have shown that up to one-third of seniors suffer from dehydration due to inadequate fluid intake. As the body ages, it naturally begins to lose its ability to retain water, leading to a 15 percent decrease in the amount of water the body has. Seniors also have decreased kidney function, which can also contribute to dehydration from alcohol use.
Diabetes - Heavy alcohol use among diabetics is associated with an exacerbation of diabetic neuropathy (nerve pain) and retinopathy (loss of vision due to blood vessel damage). Those with diabetes are instructed to have no more than one drink per sitting.
Stomach issues - Alcohol causes gastric irritation and increases the risk of upper GI bleeds by 40% in those who drink 7-27 drinks per week and 300% among those who drink 28 or more drinks per week.
Gout - The consumption of any amount of beer or liquor is associated with an increased risk of gout. In fact, medical professionals suggest that anyone with gout not consume alcohol in any amount. Drinking just one beer a day increased the risk of gout by 50%.
Insomnia - Alcohol interferes with sleep patterns as well as falling asleep and staying asleep. Older alcoholics are more likely to develop sleep-disordered breathing than those who are younger.
Depression - Research indicates that in heavy drinkers, abstinence improves depressive symptoms dramatically.
Cognitive Issues/Dementia - those with pre-existing cognitive impairment should not drink given the fact that alcohol has sedative effects and neurotoxic effects on the brain.
Liver Disease - Among women, those who drink 2 or more drinks daily and men who drink 4 or more daily increase their risk for cirrhosis of the liver 9 times compared to non-drinkers. For those with liver diseases, alcohol reduces responses to medications, accelerates the disease process, and increases the risk of liver cancer.
Seizures - Among women, those who drink 2 or more drinks daily and men who drink 4 or more daily increase their risk for seizure disorder more than 7 times compared to non-drinkers. Alcohol may also interfere with medications given to control seizures.
Breast Cancer - The risk of breast cancer developing increases by 7% with every drink consumed per day versus women who are non-drinkers.
"Nearly all research studies looking at alcohol use in older adults and seniors indicate an increase in alcohol use triggered by a number of factors created by our response to the pandemic," said Attorney Connelly. "Even of more concern are those seniors who have co-morbid mental health concerns such as anxiety and depression, who are more likely to use alcohol as a coping mechanism following stressful events such as the pandemic. Given the fact that alcohol abuse was a growing problem in this group prior to the pandemic means that our public health systems need to be prepared to reach out to these groups through messaging tailored specifically for them as the current COVID crisis begins to subside. We will also need innovative strategies to deliver these services to seniors, including telehealth and in-home counseling."